Month: December 2018

It’s the eighth day of blood sugar (reporting) and I’m over it. I’m ceasing the experiment due to ethical concerns for me, the participant.

You wouldn’t know it, but typically I’m very private about my blood sugar. This has been a big stretch. It’s been a good experiment and I have many, many thoughts to share after the holidays. For now though, I’ve realized that the extra burden of reporting has gotten me too in my head about this whole game and out of touch with the necessary and natural intuition that is one ingredient in my personal magic potion of blood sugar management.

Parting thought for now from a friend who also has T1D – “You can do everything the same way twice and not get the same results.”

Genius. So true. Also, so frustrating, if you think about it too hard. For me, having T1D is an interesting reminder that mind and body are one, and that listening to oneself is key.

So in sum – have a wonderful holiday however you choose to celebrate, and thanks for sticking with me this past week on the nighttime blood sugar sleigh ride, where Santa’s asleep at the wheel and every reindeer is in charge! [stretch metaphor 🙂 ]

I slept in an hour past my alarm (it’s ok, it’s Saturday) and my meter gave to me

a 196 mg/dl.

Yesterday I went to the gym in the middle of the day and a yoga class after work. I ate well enough and went to bed at 137 mg/dl, still with a little insulin working in my body (did not finish eating by 8 pm).

It’s hard to exercise after work and still get in a reasonably early dinner. It’s a strange trap to have to choose between the two.

But really, I think my bg crept up in the morning hours, as it does if I fail to take my 24 hr insulin around the same time every day. I had taken a little booster shot of it the night before, as is my habit on weekends. Typically I take my 24 hr insulin at 6:45 AM or so. I take a pretty small dose and it seems to wear off at almost exactly 24 hrs for me; meaning that if more is not injected to replace it, I will begin the slow rise. I meant to wake up at 8:30 AM, but my body knew better and kept on sleeping.

Health trade-offs. Not pleased about this. Blogging a number that is ‘too high’, gives me a new understanding of how kids must feel when they have to report their blood sugars to doctors or parents. Intuitively, we know that the number is not a grade or score, but it can sure feel like it. I wasn’t a kid when I was diagnosed, so I’ve always been a self-grader, but I bet it’s scary when you feel like your actions are going to be judged by others because of a blood sugar reading. I bet it feels like that sometimes even when others aren’t actually judging you.

Literally, it was gray and pouring out. I stood by my window at work and felt dampened by the weather.

Figuratively it was one of those rare days when I forget my meter at home – and this left me unmoored, confused, uncertain.

I do this, I would say, about twice a year. I realized it after walking and busing almost all the way to work. I can’t park at my work, so the thought of going back home felt to my maximum-productivity brain like a real waste of time.

In truth though, not having my meter really isn’t safe – I typically can feel my low blood sugar coming on, but I learned yesterday that I really overestimate my ability to feel where I am – so much of that ‘feeling’ is really a complex set of predictions based on my last reading, which ideally is no more than 2 hours ago. And about the safety thing – my rational brain knows that taking the two hours of sick leave it would have cost to go back home for my meter, is a lot less than the amount I would have had to take if I’d had a real problem (read: very low or high blood sugar) because of it.

Every time this happens I think of the kids with T1D who I met in Bolivia who can only test two to three times a day, max. Checking infrequently is their norm. I think of them and wonder how they manage when I feel so utterly lost.

A friend asked me how I was yesterday – I said I don’t know. I didn’t know. How I’m doing is very tied to my blood sugar, I realized anew.

Realizing anew is frustrating isn’t it? We realize, we forget, we tell ourselves it doesn’t matter, and then we have to realize anew!

Anyway, I ultimately did decide to leave work early. When I got home I was in the low 200’s. I took some insulin, did some yoga and then, as a reader so keenly pointed out in yesterday’s comments, of course went low before dinner. About 2 hours after dinner I was 130, an hour later I was 175…can I explain that? Nope. Not even a guess. Too few data points to guess. Correction dose, bed. I woke up at 3:51 AM at 150 mg/dl; at 7 AM at 131 mg/dl. Grateful to know.

“So what’s the plan?” I ask myself, because after forgetting my insulin pen one day, I installed an extra labeled in a plastic bag in our shared fridge. The plan is definitely, as of today, to store a backup meter at work. I have several from years past on different insurance plans, and I still have enough test strips left to get me through a mess up day.

*Reminder about the big, giant disclaimer: I do not have medical expertise and this is not an advice blog. I’m not saying that the way I manage is the right/safe way, or that my goals and targets are right/safe for anyone else, but rather I am simply recounting my experiences as a person living with Type 1 diabetes.

But actually, this is a star reading. Not that I’m judging my readings or assigning value (I’ve had to combat this instinct during my T1D journey) – I think I’m doing better (but clearly still like to assess progress).

Anyway, last night we didn’t even walk into the restaurant until 8 pm. At that point though, we were all starving, so we ordered and got our food quickly.

I’d gone to see a jazz band with a couple of friends; we were headed to Thai food after. These two friends and I, plus usually another, meet up regularly to discuss life and share challenges and successes. Time with them is therapeutic and restorative; as key to my health as eating vegetables or checking my blood sugar.

I had a cup of coconut soup and a chicken and green bean red curry paste stir-fry entree (lots of descriptors!). Typically at Thai, Chinese, or Japanese restaurants I invert what you might think of as the traditional rice to food ratio. I use rice as a garnish, sprinkling a bit of it on top like snow. In fact, you can think of the dots in today’s picture as either snow or rice falling onto the 115 (these are all original digital drawings by the way and totally available for purchase 😉 ).

Going out to eat is great – you try spices and flavors you wouldn’t at home and someone else cooks and cleans. But for me, the hardest thing about eating out is having to drive home afterwards. The time right after meals is some of the most difficult: biggest fluctuations in blood sugar, greatest potential for a low or high blood sugar that is going to mess with my awareness. Because I don’t drive if my blood sugar is low and I don’t love sitting alone in my car on cold winter nights waiting for my bg to rise, I took a more conservative meal time dose of insulin than I otherwise might have for the food I was eating. When I got home, my bg was 186 mg/dl. Based on the blood sugar scrutiny of the last few days, I took what I felt like was an accurate correction dose, and hooray! it was.

There are 7 more days of blood sugar left, so if you’re enjoying these posts, feel free to share with someone else who you think might as well. Thank you for being on the journey!

Well, we all know that this is the most wonderful time of the year. There are gatherings and celebrations almost every night – and for a person with T1D, this can be a little exhausting. Last night, I was really excited to have no plans other than eating my leftovers from fancy Monday night dinner the day before.

I finished dinner at 7. At 9:30, my bg was 176 mg/dl or so. The past couple nights I’ve corrected and gone a bit low, so I decided to be more conservative and take just 1 unit of insulin, even though what I probably needed was something like 1.3, as my correction is 1 unit for 60 mg/dl, roughly. What’s a correction dose? you ask – it’s a ratio to understand how much 1 unit of insulin will bring your blood sugar down from a static level. So for example, 1 unit should have brought me down to about 116 mg/dl if my correction factor was correct. But it’s never that simple. This is like the correction factor in a controlled weather chamber. So if we could separate everything else that has happened in the day out from this individual measurement of blood sugar, then we might be able to make a precise estimate such as this. But here’s the thing, so many factors affect blood sugar.

Let’s play a game. Guess which of the following do notaffect blood sugar:

stress

fat content in a meal

protein content in a meal

baths

exercise 2 hours ago

If you guessed baths, you fell for the trick! All of those things can affect blood sugar. In fact, I’ve been in a bath habit of late, because it’s relaxing, but it’s also caused me a few false lows. The heat of a bath or a shower can activate insulin such that you’ll have a blood sugar dip unexpectedly if you’ve injected insulin recently. For me, I tend to go low and then bounce back up. It seems like it is speeding up the insulin action, rather than magnifying its impact overall. For other people though, it might be a magnifying effect.

Anyway, I went to bed in the 140’s, I woke up at 2:30 AM in the 140’s, took roughly half a unit of insulin (which is a little tricky using insulin pens that only measure in 1 unit doses) and woke up at 6:40 at 146 mg/dl. Can I explain this? No. But my guess is that the fair amount of fat in my meal was slowly digesting and keeping my bg slightly elevated, despite the correction doses I took.

Moral of the story – in diabetes, nothing exists in a vacuum. No two days are the same. Rules make a complicated mess of factors sound simple when they are really not.

FIRST OF ALL, A BIG, GIANT DISCLAIMER: this is not meant to be medical advice and I do not have medical expertise. In fact, these posts are really more aimed towards those who don’t have diabetes. More on this later, but the hidden agenda is just to expose all of the different factors and decisions that go into blood sugar management. So once again, I’m not saying that the way I manage is the right/safe way, or that my goals and targets are right/safe for anyone else, but rather I am simply recounting my experiences.

On the third day of blood sugar my meter gave to me – an 86 mg/dl!

Last night I didn’t even start supper until 8 pm, which by the way, was the infamous cauliflower steaks of which I have expounded previously. This time we topped off the cauliflower puree with a fried sage leaf and served with local chicken sausage. Very upscale Monday night.

Anyway, I checked after my guests left and was high, took a correction dose, cleaned up the kitchen (time passed) – and by the time I was ready to close my eyes for sleep, was 80 mg/dl again. I knew insulin was still working in my body, so I ate a tablespoon of honey and went off to slumber.

This morning was pure luck. I have to assume, since once again I’m confronted by the continual curiosity that is not having a CGM, that I was just coasting on a flat line of blood sugar all night (not necessarily true, FYI).

By the way, ideal range for me to wake up in is 80 – 120 mg/dl. Again, that’s just me. Some people prefer/feel safer to wake up 90 – 150 mg/dl, for example. And, as a reader pointed out in yesterday’s comments, meters and CGMs are often off by 15 mg/dl or so in either direction, making it really difficult to know exactly where you are anyway.

On the second day of blood sugar my meter gave to me, a 65 mg/dl at 6:45 AM!

I would say last night I accomplished the no eating after 8 pm feat again (there were a few almonds, but who’s counting?)..

Let me explain a little more what the function of this goal might be in terms of nighttime blood sugar management. I want to be clear that it’s not just self-restraint for general health purposes.

‘Insulin on board’ is a term to describe the amount of insulin you have previously injected that is still working in your system. In general, insulin takes 20-30 minutes to become active in the body and has a duration of action of between 2 – 4 hours. That’s a big range, but I’ve noted that the max action of insulin is typically over for me after about 2 hours, and I don’t think much past 3 hours back when I’m considering insulin on board.

All this means that if I stop eating at 7 pm, like I did last night, then when I check right before bed, the number I’m dealing with will be more static, and thus easier to alter without as much unpredictability.

Last night I had a beef taco and a chicken tostada with a friend of mine at a taco stand, before going to a concert and puppet show in a shed. It was a little weird, but it fit just fine into my health resolution, so that must be a good sign.

I knew I’d be a bit high because I took a conservative insulin dose so I wouldn’t have to deal with low blood sugar while driving. When I got home later in the evening, my bg was 167. I took a unit of insulin but did not come down at all over the next hour. I took another half unit before bed.

65 is a little low. Below 70 is considered hypoglycemia. Times like these I wish I had a CGM so that I could see if I’ve been low for hours or if I had just gently arched down to this level right before bed (the latter being a preferable outcome).

I’ll explain more about ranges later. It’s important to remember as a reader, that management is highly individualized, and this is just my particular style.